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Geriatric Physiology
Dr. Leandro Vila 20 Mar 14

Why study geriatrics?
- Increased aging population
Internationally: ages 65 and above
Phils: ages 60 and above (senior citizen)
Before, the population of the developing
country was described to be pyramidal

Base (younger age) increased population
Apex (old age) - lesser population
As you go to the apex, the population is
decreased.
Developing countries nowadays have a
beehive form of population

Young population slightly decreases
Middle aged are increasing
Elderlies are increased (WHO)

- Phils- 1969-1990- increase of 146% 65
- Females-higher life expectancy
- Life span: 120 years
- Life expectancy: (there are factors that deter
human population from reaching its life span)
Female: 68 y/o , Male: 63 years old

Why not males:
- Males take more risky work
- Males take in their depression
- Based on statistics, males are more nagger
than females

Factors that make population an aging population
- Increase life expectancy
Better nutrition
More effective therapeutic and preventive
measures (disease prevention)
Better healthcare services
- Decline fertility (last 3 decades of 20
th
century)

Epidemiologic shift
- top causes of morbidity (the relative incidence
of disease) and mortality (the number of
deaths that occur in a particular time or place)
Before:
From acute and infectious diseases
(diarrhea, TB, pneumonia)
Now:
Chronic and degenerative diseases
(Parkinsons, Alzheimers)
Cardiovascular diseases and cancer (1
st
)
Cerebrovascular
COPD
Diabetes
Ranked 7
th
in the world (as of 2001)
Ranked 9
th
in the Phils. (as of 1997)

Challenge to healthcare:
- Provisions on medical and social services for
geriatric patients

Retirement has a social impact on elderly!
- They feel like they are no longer needed in the
world
- They seek refuge in social activities (church,
ballroom, etc.)
Eto daw mga sisikat specialty in the future:
Orthopedics (old aged are prone to fractures)
Geriatric Medicine
Neurology

Aging vs. senesence (forgetful)
Aging is not necessarily senescence

Aging:
- progressive increase, throughout life or after a
given stadium, in the likelihood that a given
individual will eventually die during the next
succeeding unit of time.
- Sequential alteration that will lead to
advancing age and eventually cause disease
and death
- deteriorative changes with time during post-
maturational life that underlie an increassing
vulnerability to challenges


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2 general characteristics of aging process:
1. Age-associating disease process
- occur only at an advanced age
- more prevalent among the aged
CVA, Parkinsons disease
2. Age-associating physiologic process
- occur normally in the absence of disease

Theories of aging (Stochastic theories)
1. Program theories
genetic control theories
aging is due to something inside an
organism's control control mechanisms
that trigger aging process
2. Error theories
Non-adaptation of homeostatic
failures. Cannot develop complete
immunity.
Note: di ko na nilagay yung mga examples ng
theories kasi di daw kasama sa exam.

Effects of Aging :
Nervous system
A. Memory and higher cortical functions
benign senescent forgetfulness
age-associated cognitive impairment
WAIS (Wechsler Adult Intelligence Score)
vocabulary subtest
semantic knowledge or crystallized
crystallized knowledge memory of
facts
procedural memory unaffected
episodic memory- most sensitive to
aging (declines after 70 yo)
decline in ability to learn new
information; reaction time
decline in efficiency to perform complex
tasks
decline in timed tasks (after 70 y/o)
declines steadily throughout life
slowing down of speech - in time
difficult to understand
management:
education
exercise
general cognitive activities
example: ballroom dancing
B. Visual system
optical component
thickening of cornea
less corneal curvature
less elastic lens
receptive component
Visual acuity poor esp. In low contrast
and low luminance
photoreceptors begin to deteriorate at
20 years old
Presbyopia
Starst as early as 15 years old
Will be very evident at 40 years old
difficult in contrasting green from blue
but easy to differentiate red from yellow
usually wear monochromatic colors
impairment of pupilloconstrictlon
has miotic, poorly reactive pupils
rhodopsin
tear production (iyak na walang luha)
visual field
floaters -vitreous changes

C. Auditory-vestibular system
Auditory
decreased hearing acuity
hearing frequency (presbycusis)
starts at 50 y/o
loss of hair cells for higher frequencies
NOT FOR LOWER FREQUENCIES!
decreased ability to discriminate and
understand speech
Vestibular
unsteadiness, disequilibrium, vertigo
somatosensory function
(demyelination)

D. Gustation and olfaction
30 to 60 y/o: 50% taste buds lost
Threshold to taste substances elevated
quality specific
o sucrose-stable, salt increases
retronasal route influence on taste
decreases compared to orthonasal route
olfactory threshold
perceived odor intensity
Odor naming impaired
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E. Motor system
decreased physical performance
Functional and structural decline
gait impairment and posture deformities
shuffling with short strides
altered neuromuscular control, impaired
muscle power and degenerative joint
disease
decline begins at 50-59yo
denervation > re-innervation
atrophy of type II muscles
protein metabolism and blood flow
expression of dihydropyridine
receptors
decreased conduction velocity
increased distal motor latency
ankle jerk (most common)

F. Somatic sensory
vibration sense (most commonly
affected)
vibration threshold
vibratory sensitivity
Mostly in distal lower ext
threshold to other modalities of
sensation
G. Sleep Pattern
Sleep Quality
Developed before 65 years old
Sleep maintenance
Sleep Onset
Early morning awakening
Slow wave sleep (progressive)
Disappearance of stage 4 sleep
REM and non-REM

H. Cerebral Blood Flow
CBF by 24% (8
th
decade)
More on temporal and frontal lobes
Cognitive functioning
Memory processing
SMOKER: more decreased cognitive
and memory




CVS
A. Heart
Structural
1gm/year male
1.5 gm/year female
o 0.55%BW 30y/o
o 0.9%BW 100y/o
SBP compensatory hypertrophy
5-10% diastolic lumen at rest and
myocardial mass (eccentric
hypertrophy)
ES afterload due to aortic
stiffness
in heart volume in relation to body
SA (cell mass deceased)
Dilate and thickened heart - more
oxygen needs
Biochemical
Heart mass collagen
Fat cell infiltration
actin activation
Functional (Blood vessel)

Gastrointestinal
Mouth
Component Change Component Change
Teeth Ducts
Muscle
bulk
Inflammatory
Cells

Taste buds Fibrofatty
Tissues

Scent
receptors
Basal
Secretion
-
Salivary
gland acini
Stimulated
Secretion
-
Content -
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Esophagus
Component Change Component Change
STRUCTURAL Relaxation
Latency

Compliance Threshold
Myenteric
Neurons
Peristalsis
Pressure
wave
Velocity

Thickness -
FUNCTIONAL LES basal
pressure
-
UES Basal
Pressure


Stomach
Component Change Component Change
STRUCTURAL PG Synthesis
Mucosal Cell
Number
Basal HCO
3

Production
-
Response
Injury
Stimulated
HCO
3

Production

Blood Flow Basal
Glycoprotein
Synthesis
-
FUNCTIONAL Stimulated
Glycoprotein
Synthesis

Basal Acid
secretion
/- Intrinsic
Factor

Stimulated
Acid
Secretion
Liquid
Emptying
Time

Pepsin
Secretion
- Solid
Emptying
Time
-
Gastrin
Levels
Electrical
Rhythm
-
Maagang nabubusog ang matatanda.
Decreased acid production makes
elderly full even if the food intake is
decreased.
liquid emptying time will make the
stomach distended, elderly will feel full



Small intestines
Component Change Component Change
STRUCTURAL Zinc
Absorption

Mucosal cell
number
Calcium
Absorption

FUNCTIONAL Iron
absorption

Carbohydrate
absorption
- Vitamin
B12
Absorption
-
Liquid
Absorption
- GI
Immunity

Protein
Absorption
- Intestinal
Transit
time
-
Zinc
Absorption

Decreased absorption makes elderly
prone to HYPOGLYCEMIA, iron
deficiency anemia, osteoporosis

Liver
Component Change Component Change
STRUCTURAL FUNCTIONAL
Liver mass Drug
metabolism

Hepatic
Blood Flow
Cholesterol
Secretion

Site of
Hepatocyted
Bile acid
Secretion

Number of
binucleate
cells
Liver
Function
Tests
-

Gall Bladder
Component Change Component Change
Gall bladder
emptying
- Biliary duct
size

Sensitivity to
CCK
Sphincter
of Oddi

CCK
production



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Pancreas
Component Change Component Change
STRUCTURAL FUNCTIONAL
Alveolar
nuclear size
Amylase
secretion

Alveolar
nuclear
Substance
Lipase secretion
Acinar Size HCO
3
Secretion /-
Ductal Size Pancreatic flow /-
Insulin levels
Insulin sensitivity
Cannot digest properly so absorption is
also decreased.

Colon
Component Change Component Change
Mucosal Cell
Number
Connective
tissue

Muscle Layer
Thickness
Colonic
transit time
n/a
Elastin
Content


Rectum
Component Change Component Change
STRUCTURAL FUNCTIONAL
Wall
Elasticity
Urgent
Threshold

Internal
Sphincter
Thickness
Maximum
Anal Resting
Pressure

Maximun
Rectal
Squeeze
Pressure


Endocrine System
A. Pituitary Gland
size
> patchy Fibrosis
> Focal necrosis
> Iron depositions
>micro-adenoma formation
Growth hormone
o Somatopause ( GnRH GH IGF axis
Prolactin
o Quantitative change but not biologically
significant
ACTH
o Unchanged basal plasma levels
o Peak cortisol response greater and
sustained
TSH no change

B. Adrenal gland
Cortex
decreased androgen, decreased cortisol
Gross weight
> cortical nodule formation
> fibrosis
> pigment deposition
unchanged plasma steroids (diurnal
secretion is unchanged)
DHEAS
o adenopause
o activity of 17,20 desmolase
Aldosterone- Renin System response to
salt restriction

Medulla
Urinary NE- tataas ang NE levels
hanggang gabi kaya nagigising kapag gabi
at madaling araw ang elderly
> Norepinephrine Nocturnal secretion
Plasma Epinephrine- unchanged
Tissue responsivenesss (alpha
receptors)
alterations in structure and function of
receptors

C. Thyroid Gland
Fibrosis
follicular cellularity and size
> microscopic nodularities
o insignificant Thyroid can sufficiently
maintain Euthyroid state (State of
having normal thyroid gland function)
T4 Metabolic Disposal by 50%
Peripheral Conversion of T4 to T3
o Decreased metabolism
o Fat accumulates in the thyroid gland
and can be mistaken as thyromegaly

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D. Glucose
Glucose Intolerance
Insulin is Normal or Slightly Increased
Glucose Absorption is slowed
Hepatic glucose production is delayed
Insulin Resistance
Post receptor events
Decline in lean body mass
Increase in body fat
Drugs exacerbate resistance

E. Calcium
PTH
GIT absorption
Vitamin D availability
Calcitonin

Reproductive
Male Female
Reproductive
function
Rate of
conception
Sexual interest,
activity,
capacity
(impotence,
libido and
ejaculation)
Testosterone
Basal LH
Basal FSH
(greater than
LH due to
inhibin)
Menopause
- Endocrine symptoms
(bleeding irregularities)
- Nervous system
disturbances (HA,
Mood, Insomnia, etc.)
- Metabolic Changes
(Osteoporosis)
Estrogen and
Progesterone
> FSH (15%)
>LH (13%)
Uterine Size and
Weight
Vaginal Mucosa shrinks
and opening is
narrowed


Urinary System
STRUCTURAL FUNCTIONAL
Renal Mass (1
0

Cortical)
Atherosclerotic
vessels
Cortex- atrophy of
afferent and
efferent vessels
RBF
GFR (starts after
30-40 y/o)
Na
reabsorption
K secretion
Basal pH, pCO2,
Juxtamedullary-
continuity of
afferent and
efferent arterioles
Vasa recta
unaffected
PCT-number and
length
HCO
3
-
unaffected
Concentrating
ability
total body
water ( F > M)
Thirst
mechanisms-
blunted



Respiratory System
A. Lung Function
Total lung capacity ? a little
> RV (early airway closure- air trapping)
> RV/TLC
VC (muscle weakness and chest wall
stiffness)
FEV1, FVC and FEF 25-75%
Lung function similar to young, heavy
smokers
B. Gas Exchange
O2 uptake
V/Q mismatch
Due to > intrapleural pressure collapsing
the base of the lung
C. Breathing
Response to hypercapnia and
hypoxemia
D. Lung Defense
Laryngeal and cough reflex
Mucociliary transport
change of respiratory illnesses


Wala akong words of wisdom. Basta galingan
mo. Kasi last na to this year. Walang ulitan!
WE CAN DO THEZZ!